Are transgender operations ethical

Some people argue that, because it is easier to create working female sex organs than working male sex organs, the decision over which gender to raise a child may be driven by this rather than what’s best for the child, therefore making surgery unethical. The issue is whether the procedure for sex reassignment is ethical, what would it involve? Who decides? Should it be different for children? Sex reassignment is not frequently undertaken, but is documented over the years in many different countries, so is an issue worth considering.

Sex reassignment would involve changes in hormones and reconstructive surgery, both of which should not be undertaken lightly and there is an ethical discussion over when such biological interventions should be allowed and what measures should be taken to ensure such procedures are ethical. There is, for example, the issue of whether only adults should be treated, since children cannot give consent and parents usually consent for them. On the other hand, reassignment as a child might be more straightforward and biological interventions might be safer then as well.

The question is should transgender operations be undertaken at all, and if so, when is it ethical to carry out such interventions and when is it not ethical? Transgender operations involve altering hormones and genitals to represent the desired sex and this can involve extensive interventions. One argument is that such procedures aren’t ethical as there is no need because the person is not ill. However, it is accepted by most people now that mentally a person can feel very uncomfortable in their body and this is accepted to an extent as a mental disorder, so surgery and medical procedures might be judged ethical.

Pfeiffer’s studies on rats and other studies on humans have shown that genes direct hormones and other processes so that from six weeks old the foetus will start to develop as male or female according to their genes. The XX sex chromosome leads to a female child whereas the XY sex chromosomes lead to a male child. In the XY pairing, androgens are released and they trigger the genitals to be male, otherwise the foetus will remain and grow as a female.

At birth an infant will be assigned as male or female often purely from external genitalia, and it is not hard to see that this can lead to an error as there is evidence for a few abnormalities in the foetus’s development that can lead to a mis-assignment. Something in the releasing of the hormones can go wrong, as can the acceptance of hormones by the body and the chromosomes themselves. There are examples of XXY patterns and androgenital syndrome. It could be argued that tests for these sorts of abnormalities should be carried out before sex reassignment takes place.

It could be argued that it is more ethical to reassign someone who has been wrongly reassigned for clear biological reasons rather than reasons such as someone who “feels” wrongly assigned, but there is no obvious cause. However, our feelings are very important to us so it should be as ethical as a biological reason. Gender development appears to be affected by brain lateralisation too and perhaps brain differences lead to the feelings of being wrongly assigned although we don’t as yet have the equipment or knowledge to pinpoint such causes.

Money documented the case study of an identical twin boy whose surgery went wrong and was thus brought up as a girl. Then the “girl” when an adult explained that ‘she’ had never felt comfortable as a girl and as a result became David a male. His story suggests that biological sex is very important to how someone feels, so if someone feels they are the wrong gender there is some evidence at least that it would be unethical to prevent them from becoming what felt they should be.

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